二维、三维超声与MRI对胎儿颅脑畸形的诊断对比

Compare and Contrast of the Diagnosis of Cerebral Malformation on 2D Ultrasonography, 3D Ultrasonography against MRI

目的探讨二维、三维超声与MRI对研究胎儿颅脑畸形的诊断对比.方法用二维超声行常规产前超声检查,对发现的49例胎儿颅脑畸形或可疑畸形的孕妇,加行三维超声检查,24 h内在昆明市妇幼保健院放射科行胎儿头颅核磁共振(MRI)检查,3种方法检查结果与确诊标准进行对比分析.结果 49例颅脑畸形或可疑畸形胎儿中二维误诊Dandy-Waiker畸形2例,误诊率40.0%,差异有统计学意义(P<0.05);二维超声对侧脑室扩张和单纯后颅窝池增宽的误诊率分别为26.7%,33.3%,差异有统计学意义(P<0.05);2例小头畸形,三维检出1例,漏诊1例,误诊率50.0%,差异有统计学意义(P<0.05);全前脑2例,产前MRI检出1例,另1例未检出,差异有统计学意义(P<0.05).结论二维、三维超声和MRI各有优缺点,二维超声可用于胎儿颅脑畸形的筛查,三维技术能对二维超声进行有效补充,MRI可作为超声检查的有利辅助方法,能进一步完善和纠正超声诊断.

Objective to compare and contrast the diagnosis results on 2D and 3D Ultrasonogrpahy against MRI. Method A 2D Ultrasonography was applied during a conventional prenatal sonography checking with a 3D Sonography assessment subsequently conducted to follow up on 49 fetus suspected of brain malformation.Furthermore, a MRI scan was taken within 24 hours after the 3D Sonography checking in our hospital as a final test. Data collections from all three assessments were completed, and an analysis of the comparisons of these three methods were done. Results Among these 49 fetus with confirmed or suspected brain malformation, there were two cases of misdiagnoses of Dandy-Walker Malformation assessed by 2D sonography, with a misdiagnosis rate of 40%,（P〈0.05）indicating a statistically significant result; misdiagnosis rate of Fetal Ventriculomegaly and Isolated Broadening Posterior Fossa were calculated as 26.7% and 33.3% respectively（P〈0.05）,a statistically significant result. Overall, there were two cases with Cerebellum Malformation, from in which one case was identified by MRI, and the other one was misdiagnosed, with a misdiagnosis rate of 50.0%.In total, there were 2 cases of Holoprosencephaly,in which one was identified by Prenatal MRI, and the other was misdiagnosed（P〈0.05）, a statistically significant result. Conclusions All three assessments of 2D ultrasonography, 3D ultrasonography and MRI have their own advantages and disadvantages. In short, 2D Sonography is suggested to be applied for screening out cases with brain malformation, together with 3D Sonography as a complementary assessment. MRI can also be an effective and significant complement for sonography in completing and readdressing the final ultrasonic results.